2022-2023年贵州省学校肺结核流行及接触者筛查结果的时空关联性分析

Spatial and temporal correlation analysis of school pulmonary tuberculosis prevalence and contact screening results in Guizhou Province from 2022 to 2023

目的:分析2022—2023年学校肺结核登记病例及接触者筛查结果的时空分布差异及流行趋势,识别贵州省学校结核病防控的重点时间和地区,为制定和优化贵州省学校肺结核防控工作策略提供科学依据。方法:采用“中国疾病预防控制信息系统”子系统“结核病信息管理系统”收集2022—2023年贵州省学校肺结核患者报告数据,采用“贵州省疾病预防控制云平台——学校结核病管理系统”收集2022—2023年学校肺结核接触者筛查数据,采用描述性流行病学方法对学校肺结核患者、肺结核接触者检出病例的流行特征进行分析,采用Joinpoint软件分析肺结核患者月平均登记发病率(接触者筛查患者检出率)的变化趋势,采用ArcGIS 10.6软件进行全局和局部空间自相关分析,采用SaTScan 9.7软件进行时空扫描分析。结果:2022—2023年贵州省共计报告6310例学校肺结核患者,年平均登记发病率为29.82/10万(6310/21161926),病原学阳性率为44.83%(2829/6130);筛查学校肺结核接触者255801名,检出肺结核接触者病例288例,接触者病例检出率为0.11%。Joinpoint回归模型分析结果显示,肺结核登记病例的月平均登记发病率总体上升(AAPC=0.60%,95%CI:-8.50%~10.60%,P=0.906),肺结核接触者中检出病例的月平均检出率总体呈现下降趋势(AAPC=-17.45%,95%CI:-31.43%~-0.62%,P=0.043)。局部空间自相关分析显示,肺结核登记病例中共有8个县(区)处于“高-高聚集区”,分布于毕节市的七星关区、大方县、黔西市、赫章县、织金县、纳雍县,六盘水市的钟山区、水城区。接触者检出病例中共有2个县(区)处于“高-高聚集区”,分布于毕节市的七星关区、六盘水市的钟山区。时空扫描分析显示,肺结核登记病例以大方县为中心,共涉及4个县(区)(RR=1.63,LLR=62.76,P<0.001);接触者检出病例以西秀区为中心,共涉及16个县(区)(RR=6.65,LLR=9.74,P<0.001)。结论:贵州省学校肺结核登记发病率较高,学校肺结核疫情“高-高”聚集地区主要位于毕节市,年初肺结核接触者筛查检出的肺结核患者较多。

Objective:To analyze the spatial and temporal distribution differences and epidemiological trends of the screening results of registered pulmonary tuberculosis cases and contacts in schools from 2022 to 2023,to identify the key times and regions for tuberculosis prevention and control in schools of Guizhou Province,providing scientific basis for formulating and optimizing strategies for tuberculosis prevention and control in schools of Guizhou Province.Methods:Data on tuberculosis cases reported in schools of Guizhou Province for 2022—2023 were collected using the“China Disease Prevention and Control Information System—Tuberculosis Information Management System”,while data on contacts of tuberculosis cases were gathered through the“Guizhou Disease Prevention and Control Cloud Platform—School Tuberculosis Management System”.Descriptive epidemiological methods were used to analyze the epidemiological characteristics of school tuberculosis cases and detected cases from their contacts.The trend of monthly average tuberculosis case registration rates(and detection rates from contact screening)was analyzed using Joinpoint.Global and local spatial autocorrelation analyses were conducted using ArcGIS 10.6,and spatiotemporal scan analysis was performed using SaTScan 9.7.Results:From 2022 to 2023,Guizhou Province reported 6310 school tuberculosis cases,with an annual average registration rate of 29.82/100000(6310/21161926)and a bacteriological positivity rate of 44.83%(2829/6130).A total of 255801 school contacts were screened,identifying 288 tuberculosis cases,resulting in a detection rate of 0.11%.Joinpoint regression analysis revealed the monthly average registration rate for tuberculosis cases showed an overall increase(AAPC=0.60%,95%CI:-8.50%to 10.60%,P=0.906)per month,while the monthly average detection rate among contacts decreased(AAPC=-17.45%,95%CI:-31.43%to-0.62%,P=0.043)per month.Local spatial autocorrelation analysis identified 8 counties(districts)as“high-high clusters”for tuberculosis cases,including areas in Bijie Prefecture(Qixingguan District,Dafang County,Qianxi City,Hezhang County,Zhijin County,Nayong County)and Liupanshui Prefecture(Zhongshan District,Shuicheng District).For contact cases,2 counties(districts)were identified as“high-high clusters”,located in Bijie Prefecture(Qixingguan District)and Liupanshui Prefecture(Zhongshan District).Spatiotemporal scan analysis showed that tuberculosis cases centered around Dafang County,involving 4 counties(districts)(RR=1.63,LLR=62.76,P<0.001),while contact cases centered in Xixiu District,covering 16 counties(districts)(RR=6.65,LLR=9.74,P<0.001).Conclusion:The registered incidence of tuberculosis in schools in Guizhou Province was relatively high,and the“high-high”cluster area of school tuberculosis was mainly located in Bijie Prefecture,and more tuberculosis patients were detected during tuberculosis contacts screening at the beginning of the year.